Intake Forms
» Intake Forms :

FYZICAL Pittsfield, MA looks forward to having you join our host of satisfied clients. Without you there can be no triumph. Because physical therapy without the client is intent without involvement. However inspired, it is like rain without water, only a hope. Because you Love Your Life, your independence, your day… we exist.

We look forward to welcoming you to our state-of-the-art facility and providing you the best physical therapy in Pittsfield, MA. To schedule an appointment, please call us at (413) 443-4800.

Once you have made your initial appointment, you may pre-register online by completing the interactive forms below, or you may download and print the forms, fill them out and bring them with you to your first visit. Completing the forms prior to your visit will help speed up the registration process.


Forms:

Patient Registration Form

Medical Intake Form

Dizziness Symptoms Scale

Dizziness Handicap Inventory

Neck Pain Questionnaire

Lower Extremity Functional Scale (LEFS)

Oswestry Low Back Pain Scale

Quick Dash

ABC Scale

TeleHealth Informed Consent Form

Cancellation & No Show Policy